Spectral domain OCT was once the must-have item, before the release of next-generation swept-source machines. Because of this, Topcon educational programme coordinator, Catharine Chisholm, understands why some practitioners may be hesitant, not wanting to invest in such a big-ticket item at the ‘wrong’ time.

However, she cautioned: “After many years of optometry viewing OCT as a nice-to-have luxury, the view is now changing and it is almost at the point of becoming an essential item.

“Clinically, there is no doubt that OCT adds significantly more information to the range of tests commonly employed in optometric practice. This insight refines referrals and limits unnecessary ones, bringing benefits for the patient and practice,” she added.

Ms Chisholm said optometrists need to know that everyone is feeling – or has felt – the same jitters as they develop their OCT skills and knowhow.

“Our clinical affairs team meet people who have used an OCT for a number of years and are still nervous when they see something a bit unusual, like sub-retinal fluid. Conferences and speaking to local ophthalmologists are great ways to grow your confidence.”

Ms Chisholm observed practitioners may want to look beyond scheduled training events, as important lessons can be learned by colleagues getting together and sharing their experiences. “Peer discussion sessions, where local optometrists bring cases with scans for everyone to discuss, are particularly beneficial,” she emphasised.

First mention

Topcon clinical affairs specialist, Laura Pigula, told OT it is a good idea for optical assistants to be the ones to first introduce the concept of OCT to patients, especially to those diagnosed with diabetes, AMD and glaucoma or a family history of these diseases.

“You want to capture the patient at their initial telephone call, or when they’re in booking their appointment. Front-of-house staff need to have an understanding of what OCT is,” she explained, adding: “As soon as the front-of-house staff are on board, I’ve noticed there’s a big difference.”

Ms Pigula added that some patients can worry about scans and if they carry any potential health consequences, as X-rays do.

She noted that patients will feel a lot more comfortable knowing the technology is based on light. “It’s like an ultrasound, but with light. The light goes through your pupil and it bounces back and gives us a picture – I keep it that simple,” she explains, adding: “Anything else would scare them. And yes, that means they can have it if they’re pregnant.”

"It's like an ultrasound, but with light. The light goes through your pupil and it bounces back and gives us a picture - I keep it that simple"

Man vs machine

Ms Pigula emphasised that the importance of an optometrist’s interpretation of the results needs to be highlighted alongside the potential of OCT.

An OCT scan will add to an optometrist’s toolkit for diagnosing disease, rather than replace it entirely, she added, explaining: “You can’t refer just on an OCT, you have to consider the full clinical picture. Some practitioners worry, because they see an anomaly on the scan, and feel the need to refer it.

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“Depending on the type of anomaly, it is important to consider it in relation to the reference database. By definition, not everyone is going to fit into the 95% limits of the normal population. That feature or apparent anomaly could well be normal for them.”

If an optometrist does spot an anomaly on an OCT scan, Ms Pigula advises them to ask themselves: “What would you have done if you didn’t have that OCT?”

In the coming years, Ms Chisholm believes that the widespread adoption of OCT into practice will boost the clinical skills and reputation of the profession.

“Going forward, the pressure on the NHS means that the hospital eye service will need primary care optometrists to develop sound OCT skills. It’s about outsourcing the workload, minimising unnecessary referrals, and managing more patients in the community. OCT and perhaps going forward, OCT angiography, are key to such a model,” she concluded.

Tips for beginners

Utilise the fundus photography functions on an OCT machine in the early days. You can recognise pathology on the fundus image and select it, and see what this looks like in an OCT scan, allowing practitioners to teach themselves.

Get involved with your peers, such as local optical committee meetings and create opportunities to upskill as a group.

Each new scan is a new opportunity to learn, perhaps about a new pathology or the new appearance of a familiar pathology.

Don’t be put off if you refer a patient to an NHS ophthalmologist and you receive feedback that the referral was unnecessary. Some of this feedback can be dispiriting, but try to see it as a lesson learned.